Fetal exposure to the Ukraine famine of 1932-1933 and adult type 2 diabetes mellitus.

The short-term impact of famines on death and disease is well documented, but estimating their potential long-term impact is difficult. We used the setting of the man-made Ukrainian Holodomor famine of 1932-1933 to examine the relation between prenatal famine and adult type 2 diabetes mellitus (T2DM). This ecological study included 128,225 T2DM cases diagnosed from 2000 to 2008 among 10,186,016 male and female Ukrainians born from 1930 to 1938. Individuals who were born in the first half-year of 1934, and hence exposed in early gestation to the mid-1933 peak famine period, had a greater than twofold likelihood of T2DM compared with that of unexposed controls. There was a dose-response relationship between severity of famine exposure and increase in adult T2DM risk.

Vestiges of famine: Long-term mortality impacts of early-life exposure to the 1840s famine in Estonia.

The paper investigates whether exposure to a famine in the Russian Tsarist Province of Livland in 1844-1846 in early life negatively affected survival at later ages, using individual data from two rural parishes. We follow 18 birth cohorts born between 1834-1852 until age 75 and differentiate between timing and length of exposures. We find that relative to individuals born in pre- or post- crisis years, there were no significant differences in survival from age 21-75. Cohorts with longer exposure to famine conditions had increased mortality only in short term, up to age 20. Males were more vulnerable in younger ages than females. The negative effect of adverse early life exposure on survival in later life was constrained to lower social group - the landless, but for the better-off groups the effect was constrained to younger ages. The paper highlights the importance of accounting for sex and socio-economic differences in studies exploring the effects of early life conditions on later-life survival.

Izrael Milejkowski and Hunger Disease Study in the Warsaw Ghetto.

Izrael Milejkowski (1887-1943), dermatologist and venerologist, and his research team conducted research starvation in the ghetto. The patients were taken to hospital wards, where they were monitored and subjected to various medical procedures. In meetings of the research team, the physicians reported their observations. This research led to a series of medical contributions that included descriptions of changes in diseases of hunger-starvation, anatomy, biochemistry, skin, cardiovascular, ocular, and blood morphology. We describe this unique study in the Warsaw Ghetto, which took place during World War II.

The Diaries of Besieged Leningraders (1941-1944): Representations of a Mass Famine during World War II.

During the siege of Leningrad by the Nazis and their allies between 1941 and 1944 (one of the most deadliest events of World War II), famine caused hundreds of thousands of deaths among the civilian population. How did people react to malnourishment and its impact on the body and mind? The diaries kept by hundreds of ordinary men and women provide an insight into the intimate perception of the famine as these events were unfolding. While the extent of food deprivation is heavily downplayed (even concealed) in Soviet propaganda, it is absolutely central in the diaries. At the crossroads of history and literature, this article examines the challenges of addressing the experience of hunger: the search for resources (linguistic, literary, historical), the attempts at verbalization, and the limits of language. Ultimately, the diarists furnish us with an invaluable testimony of unmitigated malnourishment, giving us the unique opportunity to it see through the eyes of the starving.

[The tragedy of starving population of the central regions of Russia in 1920-1922].

On the basis of archival documents and literary sources the importance of nutrition factors determining the importance of its influence on the level of demographic indicators and morbidity during the famine of the 1920s in the Samara Gubernia is demonstrated. The contribution of foreign public organizations in saving people from starvation is presented.

The destiny of Italian prisoners in Austro-Hungarian POW camps during the First World War: remembering the defeat of Caporetto 100 years on.

The living conditions of Italian prisoners during the First World War were extremely difficult. At the end of the conflict, the treatment of Italian soldiers in Austro-Hungarian POW camps and in those of the German territories was recognized as particularly harsh in comparison with that of other prisoners. The reasons may be ascribed to three main factors. The Italian prisoners paid the price of being considered traitors, since Italy was allied with the Austro-Hungarian Empire and with Germany until 1914, subsequently switching to the side of France, the United Kingdom and Russia. The Italian government and the Italian High Command considered their soldiers poorly inclined to engage in a war which became over time increasingly costly in terms of human sacrifice. The strategy pursued by the General-in-Chief Luigi Cadorna was very aggressive and showed little care for the life conditions of his troops, who were frequently thrown into the fray and exposed to potential slaughter. Due to this negative judgement on their troops' willingness to fight, the government did not help, and even hindered, the despatch of packages of food and clothes to prisoners in the Austro-Hungarian and German camps via the Red Cross. The idea of a better life in the trenches compared with that expected in the camps as prisoners was widespread. Thirdly, the maritime blockade of the Adriatic Sea over time reduced to starvation the populations of Austria, Hungary and Germany, which obviously had grave repercussions on prisoners. It was estimated that around 100,000 Italians lost their lives in POW camps; after the defeat at Caporetto, when over 250,000 prisoners were captured, the number of deaths rose. The main causes of death were: tuberculosis, pneumonia, malnutrition and typhoid fever. At the end of the war, when coming back to Italy, former POWs were interned for months in camps (located predominantly in the Emilia region) and had to face interrogation and trials to demonstrate they were not deserters and were free to go back home. In the meantime, many lost their lives due to "Spanish" flu, pneumonia and other infectious diseases. Only the mobilization both of families and public opinion forced the Italian government to close the camps at the end of the year 1919.

Like a jar of flies? A study of self-control in an organizational social dilemma with large stakes.

We study the practice of self-control in an organizational social dilemma when the stakes are large, using 47 years of vital census data from 18th century Sweden. From 1750 to 1800, eighty percent of Sweden lived in a simple-structure organization called a bytvång or village commons. The amount of resources a village family received was a function of their size. During this period, crop failures left the population facing starvation. Using autoregressive time-series modeling, we test whether the people of Sweden continued to take steps toward increasing the stress on the commons by marrying and birthing children or practiced self-control. We find evidence that the peasantry-with little education, archaic agricultural practices, strong barriers to abortion and infanticide, and pressures by the Church and State to procreate-were less likely to marry and birth children (in or outside of wedlock) when the quality of the previous year's harvest was poor compared to when it was bounteous. Post hoc analyses support the idea that the reason behind declining fertility after a famine was human decision rather than human physiology. Our findings are consistent with the idea that human population growth is not a social dilemma called a collective trap-which has been the assumption for 50 years. Rather, human population growth may be an individual dilemma-suggesting that members of simple-structured organizations can unilaterally exercise self-control and manage resources through self-organizing.

Patterns of frailty in non-adults from medieval London.

Famine has the potential to target frail individuals who are at greater risk of mortality than their peers. Although children have been at elevated risk of mortality during recent famines, little is known about the risks posed to children during the medieval period. This study uses burials from the St. Mary Spital cemetery (SRP98), London (c. 1120-1540) to examine the relationships among non-adult age at death, burial type (attritional or famine), and four skeletal lesions (porotic hyperostosis, cribra orbitalia, linear enamel hypoplasia [LEH], and periosteal new bone formation). Hierarchical log-linear analysis reveals significant associations between famine burials and LEH, independent of age. Significant associations also exist between age and the presence of cribra orbitalia, porotic hyperostosis, and periosteal lesions, with all three lesions present in greater frequencies among older children and adolescents, independent of burial type. The LEH results suggest that early exposure to stressors increased frailty among non-adults in the context of famine. The associations between age and the other skeletal indicators suggest that, in both famine and non-famine conditions, frailer individuals died at younger ages and before skeletal lesions could manifest, while their less frail peers survived multiple physiological insults before succumbing to death at older ages.

Stunting, starvation and refeeding: a review of forgotten 19th and early 20th century literature.

AIM: To scrutinize to what extent modern ideas about nutrition effects on growth are supported by historic observations in European populations. METHOD: We reviewed 19th and early 20th century paediatric journals in the Staatsbibliothek zu Berlin, the third largest European library with an almost complete collection of the German medical literature. During a three-day visit, we inspected 15 bookshelf meters of literature not available in electronic format. RESULTS: Late 19th and early 20th century breastfed European infants and children, independent of social strata, grew far below World Health Organisation (WHO) standards and 15-30% of adequately-fed children would be classified as stunted by the WHO standards. Historic sources indicate that growth in height is largely independent of the extent and nature of the diet. Height catch-up after starvation was greater than catch-up reported in modern nutrition intervention studies, and allowed for unimpaired adult height. CONCLUSION: Historical studies are indispensable to understand why stunting does not equate with undernutrition and why modern diet interventions frequently fail to prevent stunting. Appropriateness and effect size of modern nutrition interventions on growth need revision.

Drivers of measles mortality: the historic fatality burden of famine in Bangladesh.

Measles is a major cause of childhood morbidity and mortality in many parts of the world. Estimates of the case-fatality rate (CFR) of measles have varied widely from place to place, as well as in the same location over time. Amongst populations that have experienced famine or armed conflict, measles CFR can be especially high, although past work has mostly focused on refugee populations. Here, we estimate measles CFR between 1970 and 1991 in a rural region of Bangladesh, which experienced civil war and famine in the 1970s. We use historical measles mortality data and a mechanistic model of measles transmission to estimate the CFR of measles. We first demonstrate the ability of this model to recover the CFR in the absence of incidence data, using simulated mortality data. Our method produces CFR estimates that correspond closely to independent estimates from surveillance data and we can capture both the magnitude and the change in CFR suggested by these previous estimates. We use this method to quantify the sharp increase in CFR that resulted in a large number of deaths during a measles outbreak in the region in 1976. Most of the children who died during this outbreak were born during a famine in 1974, or in the 2 years preceding the famine. Our results suggest that the period of turmoil during and after the 1971 war and the sustained effects of the famine, is likely to have contributed to the high fatality burden of the 1976 measles outbreak in Matlab.

Victor's justice: atrocities in postwar Nigeria.

The Nigerian Government's declaration of 'no victor, no vanquished' after the capitulation of Biafra on 12 January 1970, was applauded as the right step towards reconciliation and transition from war to peace. Despite this declaration and assurance of amnesty, the Nigerian Government and its soldiers still engaged in acts that amounted to retributive justice. They starved and killed innocent Biafran civilians, looted their property and raped their women. Surprisingly, these postwar atrocities committed against former Biafrans have been largely ignored in the historiography of the Nigeria-Biafra War. This paper seeks to fill the gap in the war literature by interrogating Nigerian Government's attitude towards the postwar humanitarian crisis and crimes against humanity in former Biafra. The paper argues that former Biafrans were not fully reintegrated into the Nigerian society and that the Nigerian Government deliberately neglected them to die in large numbers, thereby making it difficult for the war victims to recover from the hardships of the conflict.

Exposure to the Chinese Famine in Childhood Increases Type 2 Diabetes Risk in Adults.

BACKGROUND: Evidence shows that exposure to poor conditions in early life is associated with an increased risk of chronic diseases in adults. OBJECTIVE: We investigated whether exposure to the Chinese famine (1959-1961) in the fetal stage or in childhood (0-9 y) was associated with type 2 diabetes (T2D) and hyperglycemia in adulthood. METHODS: We included 7801 subjects aged 56.4 ± 3.3 y from the Dongfeng-Tongji cohort. Subjects were classified into late-, middle-, and early-childhood-exposed, fetal-exposed, and unexposed groups. Excess mortality rate was used to evaluate the severity of famine. Logistic regression models were used to analyze the famine-dysglycemia associations. Generalized linear models were used to assess the famine effects on dysglycemia risk during the 5-y follow-up period among 3100 subjects. RESULTS: In descriptive analyses, the risk of T2D was significantly greater in the middle-childhood-exposed group (OR: 1.44; 95% CI: 1.10, 1.87; P = 0.007), and the risk of hyperglycemia was higher in the middle- and late-childhood-exposed groups than in the unexposed group (OR: 1.54; 95% CI: 1.26, 1.88 and OR: 1.51; 95% CI: 1.23, 1.85, respectively). In sex-specific analyses, women exposed in middle childhood (OR: 1.55; 95% CI: 1.16, 2.06) and late childhood (OR: 1.40; 95% CI: 1.05, 1.87) had a higher risk of T2D than unexposed women. This association was not found in men. Similar associations were found for hyperglycemia risk. Moreover, subjects who experienced severe famine in childhood had a 38% higher T2D risk (95% CI: 1.05, 1.81) than those exposed to less severe famine. In retrospective cohort analyses, participants who experienced famine in middle childhood had a higher hyperglycemia risk relative to the unexposed group (RR: 2.06; 95% CI: 1.08, 3.90). CONCLUSION: Exposure to the Chinese famine in childhood was related to an increased risk of adulthood T2D and hyperglycemia, particularly in women.

William Wilde: Historian.

This essay attempts to assess William Wilde as a social historian. It examines some of his contributions to the discipline of history and looks particularly at 'The food of the Irish', which was published in the Dublin University Magazine in February 1854.

Frailty and famine: Patterns of mortality and physiological stress among victims of famine in medieval London.

OBJECTIVES: Famine can be defined as a shortage of foodstuffs that instigates widespread excess mortality due to starvation, infectious disease, and social disruption. Like other causes of catastrophic mortality, famine has the potential to be selective. This study examines how famines in medieval London were selective with respect to previous stress, age, and sex. METHODS: This study compares famine burials to nonfamine (attritional) burials from the St Mary Spital cemetery, London (c. 1120-1540 AD). We evaluate the associations between age, sex, and skeletal stress indicators [cribra orbitalia, linear enamel hypoplasia (LEH), and periosteal lesions] using hierarchical log-linear analysis. Additionally, sex is modeled as a covariate affecting the Gompertz hazard of mortality. RESULTS: Significant associations exist between famine burials and LEH and between attritional burials and periosteal lesions, independent of age or sex. Sex did not significantly affect risk of mortality in the 12th-13th centuries. However, males interred in attritional burials c. 1400-1539 AD faced a lower risk of mortality compared to females. DISCUSSION: The LEH results suggest that early exposure to stressors increased frailty in the context of famine. The periosteal lesion results suggest that individuals were more likely to survive stressors and thus form these lesions under nonfamine conditions. Hazard analysis suggests that a cultural or biological transformation during this period affected sex differences in mortality. Possible causes include the selective mortality during the Black Death, which might have influenced risks of mortality among survivors, or unequal distribution of improvements in standards of living after the epidemic. Am J Phys Anthropol 160:272-283, 2016. © 2016 Wiley Periodicals, Inc.

Medical Aid, Repression, and International Relations: The East German Hospital at Metema.

Between 1984 and 1988, the German Democratic Republic (GDR) built a hospital in a remote part of Ethiopia, close to the Sudanese border. The project evolved in a complex combination of contexts, including the general foreign policy goals of the GDR, its specific alliance with Ethiopia, the famine of 1984-85, civil war in Ethiopia, and a controversial resettlement program by the government of Mengistu Haile Mariam. Though almost unknown today, it was a high-profile project at the time, which received the personal support both by Erich Honecker in the GDR and Mengistu Haile Mariam in Ethiopia. However, their interest was directed more at the political goals the project was expected to serve than at the hospital itself. Both the preparation and the implementation of the project were extremely difficult and almost failed due to problems of transportation, of red tape, and of security. The operation of the hospital was also not ideal, involving frustrated personnel and less than complete acceptance by the local population. Ironically, for all its practical difficulties, the hospital has outlived both governments and their political goals, surviving as a medical institution.

[Organization of medical support for troops, defending Leningrad and the people of the blockaded city].

The data on the composition of forces of medical services and organization of medical-evacuation support for troops defending the blockaded Leningrad are presented. The information about the health losses among the population of Leningrad as a result of bombing, shelling and disease is given. Extremely high rates of morbidity and mortality in residents were associated with hunger, hypothermia and emotional stress. The clinical picture of some diseases has different peculiarities because of alimentary dystrophy background. The city health service suffered huge losses: 482 medical institutions were destroyed, only about 300 people from 1.5 thousand of medical personnel in 1942 saved working capability. The health care service of the local air defense played an essential role in delivery of medical aid. The contribution of civil and military health workers in saving residents lives in the blockaded Leningrad was appreciated.